The objective of this research proposal is the improvement of the care of burned patients. We believe that the most rational way to achieve this end is to focus our research efforts along critical problem areas in the treatment of burned patients and direct them towards understanding the underlying pathology of burn trauma. The overall approach is a coordinated multidisciplinary effort involving clinicians and basic scientists carrying out clinical studies correlated with multiple discipline based laboratory investigations, each examining the same stressed preparation at the same time, extending from in vivo studies through the organ and cellular levels to subcellular studies. The areas that have been identified for investigation are: 1) an investigation of the protein metabolic responses producing the hypermetabolic state, 2) endocrine considerations, 3) intermediary metabolism, mitochondrial function, and carbohydrate, and fat metabolism: 4) wound healing studies designed to investigate the role of the cellular and connective tissue elements in scar formation and the sequence of events in skin following thermal injuey; 5) cardiovascular studies in the acute and chronic burn phases with particular reference to right ventricular failure and the relation of cardiac failure to pulmonary failure in the burn patient; and 6) studies of distal pulmonary burn injury including smoke inhalation in an animal model and in a clinical study, 7) study of dermal matrix changes following burn injury which are related to extension of thermal injury.